Information Collection

SSA-7162-OCR-SM--Report to U.S. SSA

IC 178733 under ICR 201905-0960-004 · OMB 0960-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7162-OCR-SM SSA-7162-OCR-SM--Report to U.S. SSA	Form and Instruction
Form SSA-7162-OCR-SM Report to United States Social Security Administration SSA-7162-OCR-SM--Report to U.S. SSA	Form and Instruction
SSA-7162 - Revised PA Statement.pdf	Other-Revised Privacy Act Statement
SSA-7162 - Revised PA Statement.pdf	Other-Revised Privacy Act Statement
SSA-7162-INST.pdf	Instruction
SSA-7162-INST.pdf	Instruction
SSA-7162-OCR-SM Report to United States Social Security Administration SSA-7162-OCR-SM - Revised Version.pdf	Form and Instruction
SSA-7162-OCR-SM Report to United States Social Security Administration SSA-7162-OCR-SM - Revised.pdf	Form and Instruction
SSA-7162-OCR-SM - Current Version.pdf Current SSA-7162-OCR-SM	IC Document
SSA-7162-OCR-SM - Current Version.pdf Current SSA-7162-OCR-SM	IC Document

IC Title:

SSA-7162-OCR-SM--Report to U.S. SSA

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	SSA-7162-OCR-SM	No	Fillable Printable
Other-Revised Privacy Act Statement		No	Paper Only
Instruction		No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 426,448

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	426,448	32,029	394,419
Annual IC Time Burden (Hours)	35,537	2,669	32,868
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-7162-OCR-SM		08/21/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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